ABSTRACT This study examined whether DID
can be successfully malingered on objective and projective
psychological tests. 50 undergraduate women were assigned
to either a Malingering or a Control condition. Each
then completed the Rorschach Inkblot Test and the
Dissociative Experiences Scale II (DES II). Analysis
indicated that subjects asked to simulate DID were
significantly more likely to endorse dissociative
experiences on the DES II in the range common to patients
with diagnosed DID than subjects asked to answer all
materials honestly. However, there were no significant
between group differences on the Rorschach. Results
suggest that the assessment of DID requires a multifaceted
approach with both objective and projective assessment
tools. Additional research is needed to assess these
issues in clinical populations.

ABSTRACT OBJECTIVE: This article reviews the English-language literature on child
sexual abuse in sub-Saharan Africa (SSA). The focus is on the sexual abuse
of children in the home/community, as opposed to the commercial sexual
exploitation of children.
METHODS: English language, peer-reviewed papers cited in the Social Sciences
Citation Index (SSCI) are examined. Reports from international and local
NGOs and UN agencies are also examined.
RESULTS: Few published studies on the sexual abuse of children have been
conducted in the region, with the exception of South Africa. Samples are
predominantly clinical or University based. A number of studies report that
approximately 5% of the sample reported penetrative sexual abuse during
their childhood. No national survey of the general population has been
conducted. The most frequent explanations for the sexual abuse of children
in SSA include rapid social change, AIDS/HIV avoidance strategies, and the
patriarchal nature of society. Child sexual abuse is most frequently
perpetrated by family members, relatives, neighbors or others known to the
child.
CONCLUSIONS: There is nothing to support the widely held view that child
sexual abuse is very rare in SSA-prevalence levels are comparable with
studies reported from other regions. The high prevalence levels of AIDS/HIV
in the region expose sexually abused children to high risks of infection. It
is estimated that, approximately.6-1.8% of all children in high
HIV-incidence countries in Southern Africa will experience penetrative
sexual abuse by an AIDS/HIV infected perpetrator before 18 years of age.

ABSTRACT The present study examines the effectiveness
of an online standardized treatment of posttraumatic
stress and pathological grief administered through
the Internet. 20 students who had experienced traumatic
life events and showed the symptoms of posttraumatic
stress participated in the study. They received credit
course points for inclusion in the research. Treatment
consisted of 10 writing sessions (45 minutes each)
during a period of 5 weeks. Participants were assessed
at pretreatment, posttreatment, and after six weeks
(follow-up). The participants improved strongly from
pre- to post-treatment on posttraumatic stress and
pathological grief symptoms and in psychological functioning.
These improvements were sustained during the follow-up
period. Moreover, 19 of the 20 participants were clinically
recovered after treatment. The changes in posttraumatic
stress symptomatology were compared post hoc to changes
in control and experimental groups from trials on
similarly protocolled but face-to-face treatment of
posttraumatic stress.

ABSTRACT Investigates the association between
objective and subjective characteristics of childhood
sexual abuse and psychopathology in later life. Ss
were 404 Dutch females (aged 16-84 yrs) who had been
sexually abused in their childhood or adolescence.
The characteristics and severity of the sexual abuse
were assessed with the Questionnaire Unwanted Sexual
Experiences in the Past(A. Lange et al, 1996)). General
psychopathology was measured with the Dutch version
of the Symptom Checklist-90-revised and the degree
of dissociation was measured with the Dissociation
Questionnaire. Stepwise multiple regression analyses
showed a moderate association between psychopathology
and objective characteristics of the abuse, such as
number of different types of abusive events and the
duration of the abuse. Variables reflecting coping
style, such as the degree of self-blame, and circumstantial
factors, such as the emotional atmosphere in the family
of origin and the reactions after disclosure, were
more strongly associated with later psychopathology.
Whether or not the abuse was incestuous did not explain
additional variance in later psychopathology.

ABSTRACT There is consistent empirical evidence
for a trauma-dissociation relation in general population
samples and in psychiatric patients. However, contradictory
findings have been reported on this relation among
substance abusers. The present study attempts to resolve
these inconsistencies by testing a series of hypotheses
related to problems regarding the measurement of childhood
abuse, the measurement of psychological dissociation,
and the potential existence of substance abuse as
a form of chemical dissociation. Alcoholic patients
(N = 155) were administered the Dissociative Experiences
Scale (DES), the Structured Trauma Interview (STI),
the European Addiction Severity Index (EuropASI),
and the Posttraumatic Stress Disorder (PTSD) section
of the Composite International Diagnostic Interview
(CIDI). The DES showed good psychometric properties.
Substantial rates of traumatization and PTSD were
observed, as well as a significant trauma-PTSD relation.
However, the mean DES score was low (11.4) and dissociation
was not related to trauma (childhood or lifetime)
or to PTSD. Years of lifetime regular medicine use,
however, was significantly correlated with the severity
of dissociative symptoms and PTSD, particularly in
males. Overall, these findings suggest that absence
of a trauma-dissociation relation in alcoholics may
not be due to measurement problems of childhood abuse
and/or dissociation. Rather, a trauma-dissociation
link may not exist, particularly in male alcoholics,
because these individuals may abuse substances to
achieve dissociative-like states. Additional research
is needed to further evaluate the utility of the DES
in alcoholic samples and to examine the notion of
chemical dissociation.

ABSTRACT BACKGROUND: The goal of this study
was to examine the neuronal circuitry underlying dissociative
responses to traumatic script-driven imagery in sexual-abuse-related
posttraumatic stress disorder (PTSD). Pilot studies
in our laboratory have shown that PTSD patients had
very different responses to traumatic script-driven
imagery. Approximately 70% of patients relived their
traumatic experience and showed an increase in heart
rate while recalling the traumatic memory. The other
30% of patients had a dissociative response with no
concomitant increase in heart rate. This article focuses
on the latter group.METHODS: The neuronal circuitry
underlying dissociative responses in PTSD was studied
using the traumatic script-driven symptom provocation
paradigm adapted to functional magnetic resonance
imaging (fMRI) at a 4 Tesla field strength in 7 subjects
with sexual-abuse-related PTSD and 10 control subjects.RESULTS:
Compared with control subjects, PTSD patients in a
dissociative state showed more activation in the superior
and middle temporal gyri (BA 38), the inferior frontal
gyrus (BA 47), the occipital lobe (BA 19), the parietal
lobe (BA 7), the medial frontal gyrus (BA 10), the
medial cortex (BA 9), and the anterior cingulate gyrus
(BA 24 and 32).CONCLUSIONS: These findings suggest
that prefrontal and limbic structures underlie dissociative
responses in PTSD. Differences observed clinically,
psychophysiologically, and neurobiologically between
patients who respond to traumatic script-driven imagery
with dissociative versus nondissociative responses
may suggest different neuronal mechanisms underlying
these two distinct reactions.

ABSTRACT OBJECTIVE: The neuronal circuitry
underlying PTSD was studied in traumatized subjects
with and without PTSD. METHOD: Traumatized subjects
with (N = 9) and without (N = 9) PTSD were studied
by using the script-driven symptom provocation paradigm
adapted to functional magnetic resonance imaging at
a 4-T field strength. RESULTS: PTSD subjects showed
significantly less activation of the thalamus, the
anterior cingulate gyrus (Brodmann's area 32), and
the medial frontal gyrus (Brodmann's area 10/11) than
did the comparison subjects. CONCLUSIONS: The findings
suggest anterior cingulate, frontal, and thalamic
involvement in the neuronal circuitry underlying PTSD.

ABSTRACT Grief and dissociation after traumatic
exposures are among the most important predictors
of posttraumatic stress disorder (PTSD). This article
introduces the Traumatic Dissociation and Grief Scale
(TDGS), a 23-item measure easily administered. The
TDGS, the Child PTSD-Reaction Index (CPTSD-RI), and
a questionnaire concerning risk factors related to
the event (losses, injury, and witnessing death and
injuries) were administered to school-aged children
who had been directly exposed to the 1999 earthquakes
in Turkey and to a nonexposed control group. Factor
analysis of the TDGS yielded four factors: perceptual
distortions, body-self distortions, irritability,
and guilt and anhedonia. A moderate positive correlation
was noted between the TDGS and the CPTSD-RI. Different
sets of risk factors were associated with the different
scale factors. The results suggest that the assessment
of psychopathology in children following a disaster
requires the complementary evaluation of symptoms
of posttrauma, dissociation, and grief.

ABSTRACT The authors present a new theory
of the neurobiological mechanisms mediating the memory
processes involved in posttraumatic stress disorder
(PTSD). The current fear-conditioning model accounts
for learning that underlies certain central features
of PTSD, but it fails to account for peritraumatic
memory disturbances, episodic memory phenomena that
also are characteristic of the disorder. A more comprehensive
model of PTSD, consistent with the clinical phenomenology
of the disorder, is proposed on the basis of observations
from human memory experiments. It is argued that the
amygdala is the locus of consolidation of the core
of the traumatic experience and that amygdalar inhibition
of hippocampal function at high levels of emotional
arousal mediates diminution of conscious memory for
peritraumatic events. The model is amenable to specific
experimental manipulations that should yield information
pertinent to further development of theory and, ultimately,
to more rational clinical intervention.

ABSTRACT Recent research suggests that victimization
imagery is chronically accessible in sex-abused populations,
which is helpful in distinguishing them from nonabused
populations. Eight categories of victimization imagery
were selectively activated by Rorschach stimuli. These
8 sex-abuse signs were replicated in a new sample
of 36 patients with continuous memory of sex abuse.
Classification accuracy was 83%. By contrast, these
signs were present in only 4% (5 of 115) of the protocols
of nonabused patients. Taken together, the 2 studies
confirm reasonably high sensitivity of the 8 signs
for sex-abused populations and high specificity for
nonabused populations. The 8 signs were also differentially
salient for patients who recovered memory of childhood
sexual trauma as adults. The Rorschach protocols of
59 of 114 patients with delayed recall of sexual abuse
possessed signs of sex abuse. There was no linkage
between therapy and recovered-memory cases with and
without sex-abuse signs. Emergence of trauma memories
was not uniquely traceable to treatment. Memories
arose outside of the context of therapy in over 56%
of the cases. Implications for the false-memory debate
are discussed.

ABSTRACT OBJECTIVE: Reduce texture sensitivity
on the Rorschach is proposed as a sequela of early
sexual abuse that is unlikely to be contaminated by
situational variables. If this conceptualization has
merit, texture attributes offer a roadmap for studying
vying claims in the recovered memory debate. To explore
this possibility, we examined the extent to which
intense preoccupation with sexual trauma of childhood
and of adult onset was related to reduced texture
productivity. METHOD: Texture productivity was measured
in 4 groups comprised of 108 patients using the Rorschach.
Twenty-seven patients with recovered memory were compared
with 27 patients with continuous memory of childhood
sexual trauma, 27 post trauma stress patients with
sexual trauma of adult onset, and 27 non-abused patients.
RESULTS: The study replicated previous findings of
reduced texture productivity among patients who always
remembered sexual trauma of childhood-onset. The same
texture deficiency pattern was observed among patients
who recovered memory of childhood sexual abuse. This
pattern was not observed in Post Traumatic Stress
Disorder (PTSD) patients intensely preoccupied with
sexual trauma of adult onset despite the fact that
they mimicked the recovered memory group in respect
to enduring preoccupation with distressing thoughts
of sexual abuse. CONCLUSION: The findings indicate
that intrusive memories of sexual trauma do not shape
patients' response to textural cues on the Rorschach.
Variations in texture productivity are primarily moderated
by age of trauma onset. Dismissal of claims of recovered
memories on the basis of intense sexual preoccupation
is not warranted.

ABSTRACT A growing number of psychiatric
patients report satanic ritual abuse, prompting research
into this controversial area. In the current study,
the Word Association Test (WAT) was modified to assess
experience with satanic abuse. Pilot work resulted
in norms for two domains: normative and satanic. Female
psychiatric patients were compared on their associations
in two studies. Based on a sexual history, they were
grouped into those reporting sexual abuse, those reporting
satanic ritual abuse (SRA), and those without a history
of sexual abuse (controls). In both studies, SRA patients
gave significantly more total associations, significantly
fewer normative associations, and significantly more
satanic associations than did the other two groups.
These results suggest that an experience base is shared
by individuals reporting SRA that is not found in
individuals who do not report satanic abuse (even
if they do report sexual abuse). The implications
of these findings are discussed from the perspective
of arguments advanced by advocates and critics of
SRA.

ABSTRACT The purpose of the present study
was to replicate Rorschach signs of Multiple Personality
Disorder (MPD) using DSM-IV criteria of Dissociative
Identity Disorder (DID). Women admitted to either
an inpatient dissociative disorder's unit (n = 27)
or a general psychiatric unit (n = 72) were given
the Rorschach, which was scored for the Labott, Barach,
and Wagner Rorschach markers of MPD. Results indicated
that Rorschach signs of the three different systems
were significantly better than chance at classifying
patients as DID or as non-DID. The Labott system,
which performed the best, was able to accurately classify
92% of the sample. These results argue for the validity
of the DID diagnosis. The Rorschach signs operate
independent of external bias, yet correspond to the
diagnoses obtained through psychiatric evaluation
in an inpatient setting. The fact that two relatively
rare sets of signs (DID and Rorschach) converge in
the same small sector of the psychiatric population
represents evidence of linkage that is clinically
meaningful and not explainable on the basis of artificial
creation.

ABSTRACT Considerable progress has been made over the past 20 years in relating specific circuits of the brain to emotional functions. Much of this work has involved studies of Pavlovian or classical fear conditioning, a behavioral procedure that is used to couple meaningless environmental stimuli to emotional (defense) response networks. 2. The major conclusion from studies of fear conditioning is that the amygdala plays critical role in linking external stimuli to defense responses. 3. Before describing research on the role of the amygdala in fear conditioning, though, it will be helpful to briefly examine the historical events that preceded modern research on conditioned fear.

LeDoux, Joseph
(1998)Fear and the brain: where have we been,
and where are we going? Biological Psychiatry
Volume 44, Issue 12 , 15 December 1998, Pages 1229-1238

ABSTRACT In recent years, there has been
an explosion of interest in the neural basis of emotion.
Much of this enthusiasm has been triggered by studies
of the amygdala and its contribution to fear. This
work has shown that the amygdala detects and organizes
responses to natural dangers (like predators) and
learns about novel threats and the stimuli that predict
their occurrence. The latter process has been studied
extensively using a procedure called classical fear
conditioning. This article surveys the progress that
has been made in understanding the neural basis of
fear and its implications for anxiety disorders, as
well as the gaps in our knowledge.

ABSTRACT In this study, the Rorschach scoring
system for splitting developed by Lerner, Sugarman,
and Gaughran (1981) was applied to the Holtzman Inkblot
Technique (HIT). Normal individuals (n = 30), patients
with neurotic disorders (n = 30), patients with borderline
personality disorder (n = 30), patients with acute
schizophrenia (n = 25), and patients with chronic
schizophrenia (n = 25) were studied with respect to
their use of splitting. Sufficient interrater reliability
was demonstrated for the scoring of splitting in the
HIT. Significant differences between borderline patients,
acute schizophrenic patients, and chronic schizophrenic
patients, on the one hand, and patients with neurotic
disorders, on the other hand, were demonstrated. Furthermore,
it was shown that the indicators of splitting were
associated with measures of identity diffusion, primitive
defense mechanisms, and other measures of psychopathology.
The Lerner indicator of splitting proved to be multidimensional.
Different forms of splitting seem to be characteristic
of borderline patients and schizophrenic patients.
The application of the Lerner criteria of primitive
defenses to the HIT appears to be promising

ABSTRACT OBJECTIVE: This study examined the
relationships of dissociation and childhood trauma
with ataque de nervios. METHOD: Forty Puerto Rican
psychiatric outpatients were evaluated for frequency
of ataque de nervios, dissociative symptoms, exposure
to trauma, and mood and anxiety psychopathology. Blind
conditions were maintained across assessments. Data
for 29 female patients were analyzed. RESULTS: Among
these 29 patients, clinician-rated dissociative symptoms
increased with frequency of ataque de nervios. Dissociative
Experiences Scale scores and diagnoses of panic disorder
and dissociative disorders were also associated with
ataque frequency, before corrections were made for
multiple comparisons. The rate of childhood trauma
was uniformly high among the patients and showed no
relationship to dissociative symptoms and disorder
or number of ataques. CONCLUSIONS: Frequent ataques
de nervios may, in part, be a marker for psychiatric
disorders characterized by dissociative symptoms.
Childhood trauma per se did not account for ataque
status in this group of female outpatients.

ABSTRACT In a recent article in this journal,
D. H. Gleaves (1996) criticized the sociocognitive
model (SCM; N. P. Spanos, 1994) of dissociative identity
disorder (DID) and argued in favor of a posttraumatic
model (PTM) in which DID is conceptualized as a consequence
of childhood abuse and other traumatic events. The
present authors demonstrate that (a) many of Gleaves's
arguments were predicated on misunderstandings of
the SCM, (b) scrutiny of the evidence regarding the
psychopathology and assessment of DID raises questions
concerning the PTM's conceptual and empirical underpinnings,
(c) the treatment literature suggests that iatrogenic
factors play an important role in the etiology of
DID, and (d) the evidence linking child abuse to DID
is more problematic than implied by Gleaves. The present
authors conclude that Gleaves's analysis underemphasized
the cultural manifestations of multiple role enactments
and that the history of DID imparts a valuable lesson
to contemporary psychotherapists.

ABSTRACT BACKGROUND: The aim of this study was to extend our knowledge of associations among the constructs of alexithymia, depression, somatization and dissociation. SAMPLING AND METHODS: 924 nonclinical subjects answered questions about depression (21-item Beck Depression Inventory), somatization (13-item somatization part of Symptom Check List-90), dissociation (28-item Dissociative Experiences Scale) and alexithymia (20-item Toronto Alexithymia Scale). In addition, a 12-item General Health Questionnaire (GHQ-12) was administered to detect psychiatric distress among subjects. RESULTS: The results suggested that there was a significant clinical correlation between somatization, dissociation, depression and alexithymia (rho varied from 0.31 to 0.56). The principal component analysis revealed the presence of four components: depression, somatization, dissociation and alexithymia. The use of factor scores diminished the covariance between measures (rho varied from -0.10 to 0.01 between the factor scores). There was almost no correlation between the dissociation factor (rho = 0.06) and alexithymia factor (rho = 0.09) scores and general distress (GHQ-12). CONCLUSIONS: This study suggests that while somatization, dissociation, depression and alexithymia are distinct constructs, they correlate to a considerable extent. The use of factor analysis and factor scores should be considered to diminish covariance between the above constructs. Comparing results between factored and unfactored results may prove illuminating. As a case in point, the results suggest that the part of dissociation that coincides with other constructs (overlaps) is associated with distress, whereas the distinct part of dissociation (no shared covariance) is not associated with distress. The same applies to the alexithymia construct. Longitudinal studies are needed to show whether there is a trait such as a relatively stable dissociation component and also whether a separate state-dependent dissociation component exists that is associated with coincident distress, somatization and depression.

Liotti G, Pasquini
P. (2000)APC School of Psychotherapy,
Rome, Italy.Predictive factors for borderline
personality disorder: patients' early traumatic experiences
and losses suffered by the attachment figure. The Italian
Group for the Study of Dissociation. Acta
Psychiatr Scand 2000 Oct;102(4):282-9

ABSTRACT OBJECTIVE: To test the hypothesis
that serious losses in the life of the attachment
figure and patients' early traumatic experiences are
risk factors for the development of borderline personality
disorder. METHOD: A multicentric hospital-based case-control
study of 66 cases and 146 controls. RESULTS: We estimated
an odds ratio of 2.5 (95% CI 1.1-5.8) for mothers'
serious losses experienced within 2 years of patients'
birth and an odds ratio of 5.3 (95% CI 2.1-13) for
patients' early traumatic experiences. Both of them
are adjusted for the confounding effect of the other
as well as for that of age, size of family and type
of patient (in- or out-patient), using a multiple
logistic function. CONCLUSION: Mourning process in
the mother within 2 years of the patient's birth and
patients' early traumatic experiences are predictive
factors for the development of borderline personality
disorder.

ABSTRACT Handedness is considered an indirect
marker for bilateral language capacity in the brain.
The Edinburgh Inventory for Handedness and the Dissociative
Experiences Scale (DES) were administered to 297 nonclinical
volunteers. Female sex, young age, and non-right handedness
accounted for 24% of the total variance on the DES,
including both pathological and nonpathological dissociative
experiences. This is consistent with the hypothesis
that cerebral lateralization indicating handedness
is a predisposing factor for dissociative episodes
especially in female subjects.

ABSTRACT Visual distortions (VDSTs) are often
incorrectly diagnosed and easily dismissed. The causes
of VDSTs are poorly understood. The aim of this study
was to investigate the link between VDSTs and dissociative
experiences in a nonclinical population. 297 nonclinical
18-80-yr-olds completed the Dissociative Experience
Scale (DES) and answered questions concerning visual
distortions. The results suggest that VDSTs are quite
common. among those Ss with self-reported VDSTs, dissociative
trends, as measured with the DES, were significantly
higher. Literature suggests that the link between
VDSTs and dissociative phenomena may be caused by
disturbances in brain lateralization. Bilateral language
capacity may interfere with abilities usually associated
with the nondominant hemisphere.

ABSTRACT Regions of the brain's frontal lobe
that are associated with memory retention and retrieval
begin to mature during the last quarter of the first
year in humans. This implies that infants younger
than 8 or 9 months should have difficulty in registering
an experience and retrieving it after a long delay.
Here we show that 13-month-old children are unable
to recall a sequence of actions performed in front
of them when they were 9 months old, whereas 21- and
28-month-olds are able to retrieve representations
of the same acts when these were witnessed at 17 and
24 months. Our findings indicate that long-term retention
increases during the second year and support the idea
that maturation of the frontal lobe at the end of
the first year contributes to memory enhancement during
this period.

ABSTRACT The emotional deficits associated
with posttraumatic stress disorder (PTSD) are the
least understood and the most understudied aspect
of the syndrome. In this study, the connection was
evaluated between traumacontext reactivity and
subsequent emotional deficits in PTSD. Combat veterans
with PTSD and well-adjusted veteran control participants
were exposed to reminders of combat, after which their
emotional behavior was assessed in response to a series
of emotionally evocative images. Under the neutral
condition, both groups exhibited emotional behavior
modulated by stimulus valence. Partially consistent
with the conceptual model described by B. Litz (1992),
the PTSD group exhibited suppressed expressivemotor
responses to positively valenced images, in comparison
with the control group, only after being exposed to
a trauma-related prime. Contrary to expectations,
the PTSD group showed no augmentation of emotional
response to negatively valenced cues after being exposed
to trauma reminders. However, the PTSD group responded
to all images, in both prime conditions, with higher
heart rate reactivity, suggesting an automatic preparation
for demand or threat in any uncertain emotional context.
Possible causes and consequences of these results
are discussed.

ABSTRACT This study investigated the prevalence
of dissociative disorders in a day hospital and examine
their relation to traumatic experiences. Trained clinicians
evaluated 70 of 229 patients consecutively admitted
to an acute care day hospital. Six of the 70 patients
(9%) received a definite diagnosis of a dissociative
disorder. Five of the 6 patients reported a history
of childhood sexual or physical abuse. The results
indicate that dissociative disorders are not rare
among general psychiatric patients and are associated
with histories of childhood trauma. -Ross, Colin A.
Epidemiology of multiple personality disorder and
dissociation. Psychiatric Clinics of North America,
14(3), Sept 1991, 503-17. This study surveyed 454
adults from the general population in the city of
Winnipeg, Canada and found that MPD related to childhood
abuse affected about 1% of the subjects. Approximately
10% of the subjects had a DSM-III-R dissociative disorder
of some kind. It is concluded that pathologic dissociation
appears to be about as common as anxiety, mood, and
substance abuse disorders.

ABSTRACT Two longitudinal attachment studies of families at social risk have now followed their cohorts of infants to late adolescence. Several key findings have emerged related to outcomes of interest to psychoanalysts. First, data from both studies indicate that disorganized attachment behaviors in infancy are important precursors of later dissociative symptomatology. Second, this early vulnerability is related to patterns of parent-infant affective communication, particularly quieter behaviors like emotional unavailability or role reversal, and does not appear to reside in the infant alone. Finally, the results suggest that the quality of the attachment relationship may in part account for why some people exposed to later trauma develop dissociative symptoms and others do not. To paraphrase Dori Laub (1993), the mother's seeing and not knowing in infancy may be a precondition of her child's knowing and not knowing in late adolescence. It remains unclear, however, whether the early relationship is predictive due primarily to the onset of an internal defensive process in infancy or whether its predictive power resides primarily in enduring patterns of parent-child dialogue that continually reinforce the child's segregated and contradictory mental contents.